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Dual Atrioventricular Nodal Non–Re-Entrant Tachycardia

ABSTRACT: A patient presented with symptoms of palpitations. Her standard 12-lead electrocardiogram captured 3 potential causes of her symptoms (premature atrial contractions, junctional rhythm, and narrow complex tachycardia). Further workup uncovered dual atrioventricular node physiology with 1:2 sinus conduction and resultant alternating QRS from a slow and fast conduction pathway. (Level of Difficulty: Intermediate.) Central Illustration

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PROVIDER: S-EPMC10240265 | biostudies-literature | 2023 May

REPOSITORIES: biostudies-literature

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Artificial intelligence-enabled electrocardiogram to distinguish atrioventricular re-entrant tachycardia from atrioventricular nodal re-entrant tachycardia.

Project description:BackgroundAccurately determining arrhythmia mechanism from a 12-lead electrocardiogram (ECG) of supraventricular tachycardia can be challenging. We hypothesized a convolutional neural network (CNN) can be trained to classify atrioventricular re-entrant tachycardia (AVRT) vs atrioventricular nodal re-entrant tachycardia (AVNRT) from the 12-lead ECG, when using findings from the invasive electrophysiology (EP) study as the gold standard.MethodsWe trained a CNN on data from 124 patients undergoing EP studies with a final diagnosis of AVRT or AVNRT. A total of 4962 5-second 12-lead ECG segments were used for training. Each case was labeled AVRT or AVNRT based on the findings of the EP study. The model performance was evaluated against a hold-out test set of 31 patients and compared to an existing manual algorithm.ResultsThe model had an accuracy of 77.4% in distinguishing between AVRT and AVNRT. The area under the receiver operating characteristic curve was 0.80. In comparison, the existing manual algorithm achieved an accuracy of 67.7% on the same test set. Saliency mapping demonstrated the network used the expected sections of the ECGs for diagnoses; these were the QRS complexes that may contain retrograde P waves.ConclusionWe describe the first neural network trained to differentiate AVRT from AVNRT. Accurate diagnosis of arrhythmia mechanism from a 12-lead ECG could aid preprocedural counseling, consent, and procedure planning. The current accuracy from our neural network is modest but may be improved with a larger training dataset.

| S-EPMC10123507 | biostudies-literature

Atrioventricular nodal re-entrant tachycardia unmasking cardiac sarcoidosis: a clinical case report.

Project description:BackgroundSarcoidosis is a rare disease, and cardiac involvement is seen in the minority of patients. The clinical symptoms depend on the location of the noncaseating granulomas in the heart and vary from asymptomatic to atrioventricular (AV) conduction block, ventricular arrhythmia, heart failure, and sudden cardiac death. Clinically manifest cardiac sarcoidosis seldomly presents with supraventricular tachycardia.Case summaryWe present a case where a female patient presented with AV nodal re-entrant tachycardia as an uncommon initial presentation of cardiac sarcoidosis. Her resting electrocardiogram showed a complete left bundle branch block and first-degree AV conduction block. During hospitalization, there was continuous switching between sinus rhythm with first-degree AV block, 2:1 AV block, and AV nodal re-entrant tachycardia.DiscussionIt is important to be aware that cardiac sarcoidosis can rarely present with supraventricular tachycardia as initial symptom. Given the elevated risk of sudden cardiac death, early detection is crucial and all patients who require permanent pacing should be considered for implantable cardioverter-defibrillator implantation.

| S-EPMC11498048 | biostudies-literature

Endocardial wavefront propagation guiding atrioventricular nodal re-entrant tachycardia ablation after modified Fontan.

Project description: Not available

| S-EPMC11781883 | biostudies-literature

Automatic algorithmic driven monitoring of atrioventricular nodal re-entrant tachycardia ablation to improve procedural safety.

Project description:BackgroundDuring slow pathway modification for atrioventricular nodal reentrant tachycardia, heart block may occur if ablation cannot be stopped in time in response to high risk electrogram features (HREF).ObjectivesTo develop an automatic algorithm to monitor HREF and terminate ablation earlier than human reaction.MethodsDigital electrogram data from 332 ablation runs from February 2020 to June 2022 were included. They were divided into training and validation sets which contained 126 and 206 ablation runs respectively. HREF in training set was measured. Then a program was developed with cutoff values decided from training set to capture all these HREF. Simulation ablation videos were rendered using validation set electrogram data. The videos were played to three independent electrophysiologists who each determined when to stop ablation. Timing of ablation termination, sensitivity, and specificity were compared between human and program.ResultsReasons for ablation termination in the training set include short AA time, short VV time, AV block and VA block. Cutoffs for the program were set to maximize program sensitivity. Sensitivity and specificity for the program in the validation set were 95.2% and 91.1% respectively, which were comparable to that of human performance at 93.5% and 95.4%. If HREF were recognized by both human and program, ablations were terminated earlier by the program 90.2% of times, by a median of 574 ms (interquartile range 412-807 ms, p < 0.001).ConclusionAlgorithmic-driven monitoring of slow pathway modification can supplement human judgement to improve ablation safety.

| S-EPMC10352454 | biostudies-literature

Cannon waves in atrioventricular nodal re-entry tachycardia.

Project description: Not available

| S-EPMC3563914 | biostudies-literature

Incidence of atrial fibrillation in patients with atrioventricular nodal re-entrant tachycardia and its association with long-term outcome.

Project description:BackgroundAtrioventricular nodal re-entrant tachycardia (AVNRT) is the most common paroxysmal supraventricular tachycardia. We sought to investigate the incidence of atrial fibrillation in patients with electrophysiologically confirmed/ablated AVNRT and its association with transient ischemic attack (TIA)/stroke as well as mortality during long-term follow-up.MethodsFrom the Karolinska Ablation Registry, 2855 consecutive patients with a first-time ablation for AVNRT between 2005 and 2018 were analyzed.ResultsPatients were 52.1 ± 15.9 years old and 59.3% were women. During follow-up of up to 10 years (median 6.0 years; interquartile range 3.3 to 9.2 years), new onset or recurrence of atrial fibrillation occurred in 317 (11.1%) patients (incidence rate 19 cases per 1000 person-years). Excluding those with history of atrial fibrillation, new onset of atrial fibrillation occurred in 153 (6.1%) patients. In multivariable analysis, history of atrial fibrillation, arterial hypertension, history of TIA/stroke, and heart failure remained independently associated with new onset or recurrence of atrial fibrillation during follow-up. Death of any cause and TIA/stroke occurred in 141 (4.9%) patients and 107 (3.7%) patients, respectively. In multivariable analysis, occurrence of atrial fibrillation during follow-up remained independently associated with both outcomes. The prevalence of atrial fibrillation according to age at the end of follow-up was high among young patients (<60 years of age: 12.7%; 60-69 years of age: 10.6%).ConclusionIn this large cohort of patients with diagnosed AVNRT, the incidence of atrial fibrillation was high (11.1%) during long-term follow-up. Occurrence of atrial fibrillation during follow-up remained independently associated with death for any cause as well as with TIA/stroke. Therefore, a closer monitoring for atrial fibrillation in patients with AVNRT including those at young age is advisable.

| S-EPMC11385394 | biostudies-literature

Severe Heart Failure Associated With Tachycardia-Induced Cardiomyopathy Due to Incessant Atrioventricular Re-Entrant Tachycardia.

Project description:Short RP interval atrioventricular re-entrant tachycardias do not typically present as an incessant form. We present 2 cases of incessant atrioventricular re-entrant tachycardias leading to tachycardia-induced cardiomyopathy with severe heart failure presentation in middle-aged adults. Both underwent accessory pathway ablation and recovered normal left ventricle function before hospital discharge. (Level of Difficulty: Intermediate.).

| S-EPMC8311047 | biostudies-literature

Mechanical circulatory support as bridge to recovery in an 8-year-old girl with tachycardia-induced cardiomyopathy due to atypical atrioventricular nodal re-entrant tachycardia: a case report.

Project description:BackgroundIncessant tachycardias can severely impair cardiac function, which is known as tachycardia-induced cardiomyopathy (TIC). The cornerstone of successful therapy is heart rate control. Otherwise, heart failure requiring mechanical circulatory support (MCS) and ultimately heart transplantation may evolve. We report a case of successful weaning from MCS after severe TIC due to the very rarely incessant atypical atrioventricular nodal re-entrant tachycardia (aAVNRT) with subsequent successful radiofrequency ablation (RFA).Case summaryAn 8-year-old girl was transferred to our unit with severely impaired cardiac function and went into circulatory collapse, including cardiopulmonary resuscitation. Stabilization was possible only by MCS, first by venoarterial extracorporeal membrane oxygenation, switched to long-term MCS (Berlin Heart EXCOR® Pediatric). However, pharmacological control of heart rate allowed myocardial recovery and finally the device was successfully explanted. As TIC was causative for the cardiomyopathy, the patient underwent invasive electrophysiological mapping and subsequent curative ablation of an aAVNRT.DiscussionThis case report describes technical considerations of both the special electrophysiological aspects of this rare tachycardia and the weaning protocol from a pulsatile ventricular assist device in a young child who finally recovered from TIC. Pharmacological heart rate control delayed curative RFA until explantation of the MCS.

| S-EPMC11487481 | biostudies-literature

Myocardial Infarction by a Myocardial Bridge in the LAD Combined With Atrioventricular Re-Entrant Supraventricular Tachycardia.

Project description:We present the case of a patient who presented with palpitations and was found to have atrioventricular re-entrant tachycardia with unusually elevated cardiac biomarkers. A coronary computed tomographic angiography showed a myocardial left anterior descending artery bridge; an accessory pathway was ablated, and cardiac magnetic resonance revealed anteroseptal myocardial infarction resulting from hypoperfusion during tachycardia caused by the left anterior descending artery myocardial bridge. (Level of Difficulty: Intermediate.).

| S-EPMC9481890 | biostudies-literature

Frequent inappropriate implantable cardioverter defibrillator therapy was determined to be dual atrioventricular nodal non-reentrant tachycardia: A case report.

Project description:RationaleDual atrioventricular node non-reentrant tachycardia (DAVNNRT) is a rare arrhythmia. We present a case of inappropriate implantable cardioverter defibrillator (ICD) therapy caused by DAVNNRT. DAVNNRT is easily misdiagnosed as atrial fibrillation and is often identified as ventricular tachycardia (VT) by the supraventricular tachycardia-ventricular tachycardia (SVT-VT) discriminator of the ICD.Patient concernsA 73-year-old man with ischemic heart disease (IHD) presented with palpitations accompanied by dyspnea and syncope. Frequent multifocal premature ventricular beats and non-sustained ventricular tachycardia were observed on ambulatory electrocardiography. The left ventricular ejection fraction decreased to 32%.DiagnosisHe was diagnosed with IHD, heart failure with reduced ejection fraction (HFrEF), and VT.Interventions: Initially, the patient received a single-chamber ICD implantation for secondary prevention of sudden death. He then suffered from inappropriate anti-tachycardia pacing (ATP)/shock therapy many times after the procedure. DAVNNRT was confirmed in an electrophysiology study (EPS), and radiofrequency ablation of the slow pathway successfully terminated this tachycardia.OutcomesNo episode of inappropriate ICD therapy or tachycardia occurred during the follow-up.LessonsIn conclusion, it is essential to have a full understanding of DAVNNRT and eliminate slow pathways for patients with DAVNNRT and be prepared to implant an ICD.

| S-EPMC8036121 | biostudies-literature

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